Problems of vaccination of children with allergic diseases. The vaccination problem is based on real conflicting facts

Worldwide, 12 million children die each year from potentially vaccine-preventable infections. It is impossible to determine the number of children who have become disabled, as well as the costs of treatment. At the same time, 7.5 million children die due to diseases for which there are currently no effective vaccines, and more than 4 million die from diseases that are completely preventable through immunoprophylaxis.

The history of modern vaccine prevention began in 1796, when English doctor E. Jenner (1749-1823) vaccinated the first inhabitant of the Earth against smallpox. Currently, the world community views vaccination as the most economical and affordable way fight against infections and as a means of achieving active longevity for all social strata of the population in developed and developing countries. Accumulated evidence convincingly suggests that the risk of adverse reactions to the administration of modern vaccines is disproportionately lower than when a corresponding infection occurs. The triumph of vaccination was the eradication of smallpox throughout the world. .

Immunization serves as the main and leading method of prevention, this is due to the peculiarities of the mechanism of transmission of the infectious agent and the persistent nature of post-infectious immunity. This primarily concerns respiratory tract infections, but for many diseases with other transmission mechanisms, vaccination of the population is a decisive direction in their prevention. For example, polio and neonatal tetanus became manageable only after receiving and wide application appropriate vaccines. Their effectiveness has now made it possible to set the task of their complete elimination. Routine immunization has become a decisive and effective measure in the fight against such infections as diphtheria, whooping cough, and measles. With the introduction of National Vaccination Schedules, significant progress has been made in the control of vaccine-preventable diseases in many countries. . Mainly, successes in this direction were achieved in European countries, the USA, Canada and some others, where the incidence of diphtheria and tetanus decreased so much that by the early 1970s these infections no longer posed a health problem. Currently, in such countries, the incidence of these infections has been practically reduced to zero, and very impressive successes have also been achieved in the fight against other diseases that cause significant socio-economic damage (rubella, Haemophilus influenzae and meningococcal infection and etc.) .

The problem of incomplete vaccination coverage of children is acute in African countries. More than 6 million children in sub-Saharan Africa are not receiving the full three-dose series of diphtheria, tetanus and whooping cough vaccine. The study examined 27,094 children aged 12-23 months from 24 sub-Saharan countries. A study of the main factors for refusal to vaccinate showed that refusal to vaccinate in these countries was influenced by the lack of formal education of the mother (OR 1.35, 95% CI 1.18 to 1.53) and father (OR 1.13, 95% CI 1.12 up to 1.40), low financial wealth of the family, mothers’ access to the media increases the level of refusal to vaccinate.

Also important factors refusal to vaccinate are living in an urban area (OR 1.12, 95% CI 1.01 to 1.23), high illiteracy rates (OR 1.13, 95% CI 1.05 to 1.23), and living in a country with a high fertility rate (OR 4.43 , 95% CI 1.04 to 18.92) .

Modern medicine considers vaccination as the most effective and most cost-effective way to prevent infectious diseases. However, at all stages - from the production of vaccines to the consequences of vaccination given to a particular child - there are many real problems. Problems whose solution will make vaccination even more effective, safe, and convenient.

We have already talked about some problems - the relationship between the fundamental possibility of vaccination in general and the use of specific vaccines in particular with financial well-being countries, the presence of additional substances in vaccines besides the immunogen, difficulties with transportation and storage of drugs, the risk of technical errors during vaccination, etc. It is clear that the list of difficulties is not limited to this list, and therefore I would like to draw the readers’ attention to some more problems . So what are the problems modern vaccination?

Modern vaccination - problems

Impossibility of practical prediction of vaccination complications

We have already written that complications, unlike vaccination reactions, are not so much a manifestation of the reactogenicity of the drug, but an individual feature of the immune system of a particular child. The dream of practicing doctors remains some kind of mass test examination, based on the results of which we can say: this child cannot be vaccinated against measles, for example, but this one can.

Unfortunately, many parents are convinced that such tests exist; moreover, this belief is often supported by anti-vaccination literature - they say that doctors are to blame for complications because “they didn’t even bother to order any tests.” The paradoxical situation is further aggravated by the fact that, firstly, no one can say what tests are needed, and secondly, the demand for examinations is ready to be met by many commercial laboratories offering numerous but unreliable “vaccination tests” or "pre-vaccination tests".

There is one more nuance regarding examination before vaccinations - the development of vaccine-associated infections in children with severe congenital immunodeficiency that was not diagnosed before vaccination. This, by the way, is one of the arguments of those who believe that vaccination should be done later. Now if we didn't BCG vaccination on the third day after birth, but instead the child was observed and his immunological status was examined - this way we would have identified immunodeficiency in time, and the child would not have had a generalized BCG infection.

It is with sadness that we have to admit that the formal correctness of this statement has no practical exit. Firstly, even economically developed countries cannot afford mass examination of immunological status; secondly, and this is perhaps the most important thing, modern medicine does not have effective methods for treating severe congenital immunodeficiencies. The examination will help avoid a fatal vaccination, but will not protect against the fatal staphylococcus or the inevitable rotavirus.

“Childhood” diseases in adults - the problem of vaccination

In the context of mass vaccination, there is a clear tendency for adults to become ill with common childhood infections more often. And measles, rubella, mumps and chickenpox in adults are much more serious and severe compared to children. Nevertheless, the solution to this very real problem is quite possible and possible in two ways: firstly, timely revaccination of adults and, secondly, mass vaccination of children.

The paradox of the situation lies precisely in the fact that the “maturation” of childhood infections occurs only when less than 80-90% of children are vaccinated (it varies for different diseases). The more people refuse vaccination than more contraindications to vaccinations, the more often adults will get sick. The described state of affairs is perfectly illustrated by the WHO position regarding vaccinations against chickenpox: if the state cannot afford to vaccinate more than 90% of children, there is no need to include this vaccination in the vaccination calendar.

Difficulties in obtaining information - the problem of vaccination

The lack of adequate information regarding vaccinations is very current problem. Acute shortage clear propaganda materials, lack of persons capable and willing to explain and explain. Parents often cannot obtain basic information about which vaccine preparation will be used for vaccination.

Organization of vaccinations - the problem of vaccination

The problems of modern vaccination are familiar to anyone who has visited a clinic with a child. The busyness of doctors and the initiative of nurses, queues and contact with sick children in the corridor of the clinic, the impossibility public control compliance with the rules for storing vaccine preparations, violation of vaccination techniques, lack of conditions for qualified emergency care in the event of complications, and much more.

The complexities of statistics

The presence of poor healthcare in general and poor doctors in particular raises the possibility of an absolutely criminal situation when vaccinations are not given, but a document on their implementation is purchased. In some territories, the number of children vaccinated with paper reaches 10%, which subsequently gives rise to talk about the ineffectiveness of vaccinations and the fact that there is no herd immunity does not exist - indeed, where did the measles outbreak come from if 90% of children are vaccinated (supposedly vaccinated!). Another statistical nonsense is late or non-informing of regulatory authorities about the occurrence of health deviations associated or possibly associated with vaccination.

Help with complications - the problem of vaccination

Often there is an immoral situation when a society that encourages vaccination, if complications arise, simply removes the victim from its members: a person who has become disabled as a result of vaccination cannot survive on compensation payments provided by the state.

Anti-vaccination - the problem of vaccination

Unique problem. In fact there is great amount smart, intelligent, conscientious people who are capable of creating a powerful social movement aimed at solving the real problems of vaccination described above. But a dozen extremists appear who manage to lead this spontaneous movement, using false, unproven and unverified information, distortion of facts, emotional slogans that have no scientific basis. As a result, there is a real problem: instead of constructive optimization of the most effective way to prevent infections, we have a deliberately destructive social movement.

Modern vaccination - challenges

Vaccination is a method of creating immunity against a certain infectious disease through the administration of an appropriate vaccine. Sometimes the concept of “immunization” is used as a synonym for the word “vaccination,” which is not entirely true. Immunization combines all methods of creating immunity - not only vaccinations (when the body produces protective antibodies on its own), but also the introduction of serums, immunoglobulins, blood, plasma for therapeutic or prophylactic purposes (when the body receives ready-made protective antibodies).

What are the objectives of modern vaccination?

The main task of modern vaccination is to achieve the production of specific antibodies in quantities sufficient to prevent a specific disease. A single injection of an immunogen into the body (as during vaccination, for example, against measles or rubella) is not always enough to ensure the proper level of immune protection. Sometimes two or even three such administrations are required (if we talk about diphtheria, whooping cough and tetanus).

The starting (protective, created through vaccination) level of antibodies gradually decreases, and repeated administrations vaccine preparation to maintain them (antibodies) required quantity. These repeated injections of the vaccine are revaccination. However, many mothers and fathers are mistaken and mistakenly believe that the first administration of a vaccine is vaccination, and all subsequent ones are revaccination. Therefore, we repeat once again:

vaccination - administration of a vaccine to create immune protection;

revaccination - administration of a vaccine to maintain immune protection.

Unfortunately, situations are possible when the introduction of a vaccine does not solve the main task of vaccination described above. In other words, vaccinations are done “as expected,” but some of those vaccinated are not able to develop enough antibodies to prevent a specific disease.

How effective is vaccination?

The effectiveness of vaccination is actually the percentage of vaccinated people who responded to vaccination by forming specific immunity. Thus, if the effectiveness of a certain vaccine is 95%, this means that out of 100 vaccinated people, 95 are reliably protected, and 5 are still at risk of disease. The effectiveness of vaccination is determined by three groups of factors.

Factors dependent on the vaccine product:

properties of the vaccine itself, which determine its immunogenicity (live, inactivated, corpuscular, subunit, amount of immunogen and adjuvants, etc.);
the quality of the vaccine product, i.e. the immunogenicity is not lost due to the expiration of the vaccine or due to the fact that it was improperly stored or transported.

Factors depending on the person being vaccinated:

genetic factors, which determine the fundamental possibility (or impossibility) of developing specific immunity;
age, because the immune response is most closely determined by the degree of maturity of the immune system;
health status “in general” (growth, development and malformations, nutrition, acute or chronic diseases, etc.);
the background state of the immune system - primarily the presence of congenital or acquired immunodeficiencies.

Compliance with the rules and techniques of vaccination

For each vaccine product, rules for use have been determined, which include the optimal age at the time of vaccination and revaccination, the choice of dose and the interval between doses, the frequency and method of administering the vaccine into the body. Violation of the rules reduces the effectiveness of vaccination; During the vaccination process, technical errors are possible when the drug is dosed incorrectly, is administered in the wrong place, is not completely dissolved, is not stirred enough, is diluted in the wrong way, etc.

We examined the concept of “vaccination effectiveness” quite narrowly, analyzing factors that can influence the formation of specific immunity in a particular child. At the same time, the effectiveness of vaccination has another meaning, since it relates to immune defense all children, the entire population. The essence of this protection is herd immunity.

Any infectious disease as a phenomenon, as a fait accompli, requires the existence of three mandatory conditions, three links in the infectious process:

source of infection;
ways of transmission of infection;
people sensitive to this infection.

If you eliminate at least one link (and this is exactly what vaccination does, eliminating link number three), infectious process will stop. The more people are vaccinated, the less intense the infection process is. If the number of vaccinated people exceeds 90-95%, the infectious process usually stops.

This is the essence of herd immunity: 90-95% of vaccinated people ensure 100% effectiveness of vaccination, since 5-10% who do not have specific antibodies are reliably protected by herd immunity. Herd immunity does not happen once and for all. He needs to be watched, he needs to be supported. A decrease in the number of vaccinated people inevitably leads to a loss of collective protection and, as a consequence, to the emergence of diseases.

Each state develops its own vaccination policy. This policy provides a list of diseases for which vaccination prevention is considered appropriate or mandatory, as well as a set of rules governing the vaccination process itself: the choice of drugs, indications, contraindications, conditions, doses, methods, timing and intervals of vaccinations and revaccinations.

PEDIATRIC NEUROLOGIST ABOUT VACCINATIONS Emelyanova Nadezhda Borisovna, pediatric neurologist, Moscow I worked as a pediatrician in a kindergarten and vaccinated children. At the institute they literally explained to us how it works the immune system, and now it’s strange to me why I was satisfied with these “explanations”. If professors of immunology are perplexed about the complexity of immunity, discovering more and more new mechanisms in its functioning, admitting that they know very little about immunity, that vaccines are dangerous, then why did everything seem clear and simple to me?! For example, this is what Doctor of Medical Sciences, Professor, Leading Researcher of the Biotechnology Laboratory at the Institute of Immunology of the State Scientific Center of the Ministry of Health of the Russian Federation writes. Ignatieva G. A.: “Vaccination is theoretically the best method of immunotherapy and immunoprophylaxis. But there are problems, the most difficult of which we will outline. The biggest challenge is the biohazard of the vaccinating drugs themselves, regardless of the target antigen. The fact is that all modern vaccinating drugs are obtained using biotechnology methods using animal serums and cells. Animals, as we learn more and more, have infections such as prion and retroviral that are extremely dangerous for humans. It is fundamentally impossible to purify the vaccine from impurities potentially containing these infections (without losing the actual vaccinating antigen). This serious accompanying phenomenon forces us to admit that by vaccinating the population, medicine unknowingly violates the basic principle of “do no harm.” And now, when I hear from pediatricians that vaccines “train” the immune system, that they protect against infectious diseases that vaccines are safe makes me sad and worried, because the price of such poor “explainers” is children’s health and children’s lives. When the downside of vaccination was revealed to me, which is not advertised or presented at the institute, I became scared and ashamed. It's scary because I finally realized what I had done to my own child, I understood where the “legs” of his sores come from and what such “concern” for his health entails. And it’s a shame - because I, being a doctor, bearing responsibility for the health of the children entrusted to me, was so thoughtless and easy about vaccination, and yet, according to Mr. Onishchenko (the country’s chief sanitary doctor), it is “a serious immunobiological operation.” Here my fellow pediatricians can reproach me: “It’s clear that vaccination is not a game of tricks, it’s necessary.” individual approach!“ It's all about the DEGREE of awareness of the depth of the problem. I also very strictly selected children for vaccination - mandatory inspection, thermometry, anamnesis (and so that no one in the family gets sick or sneezes!), when necessary - tests, in a word, everything that can be done in a clinic... But we must admit that these are minimal data (and in a clinic they are - maximum), do not say ANYTHING about the state of immunity and health in general in a particular child. And there is no need to be deceived and deceive parents - even a detailed immunogram and consultation with an immunologist will not protect the child from the side effects of vaccines, will not guarantee that the vaccine will not provoke a serious autoimmune disease, that it will not disrupt the subtle mechanisms of self-regulation and the child will not develop diabetes or bronchial asthma , blood cancer or other incurable disease. If parents really understood what kind of roulette they were playing, then many would think about it... I understood and thought about it. Now it is almost impossible to make a diagnosis of “Post-vaccination complication.” The doctor who did this signs his own death sentence, so no one makes such diagnoses in order to avoid trouble. Therefore, WE DO NOT KNOW how many children actually suffered from vaccination, and we think that very few (one in a million) will “carry over” this time too... I saw a child, six months old, who experienced clinical death on the third day after vaccination . They revived him, but he will be an idiot because his cerebral cortex is dead. NONE of the doctors “remembered” that three days before clinical death they did it to him DTP vaccination. We have a lot of conversations about the so-called concept informed consent for medical intervention, in particular vaccination. In fact, this is an empty phrase. A parent, wishing to vaccinate his child, should know that: 1. According to Russian legislation, HE HAS THE RIGHT to refuse vaccination (for any reasons, including religious ones) and this refusal will not entail ANY consequences in the form of non-admission to kindergarten, school, institute. And those citizens who create obstacles for such parents must deal with the prosecutor’s office. 2. The parent should know that vaccines are not medicines, they are dangerous and grossly interfere with the immune system; should know what they consist of, how they are tested and what complications exist after vaccination. Therefore, the parent must give WRITTEN consent to vaccination and AFTER he has read and understood that vaccines contain merthiolate, foreign DNA, which vaccination can provoke diabetes, cancer, autoimmune diseases, cause death. Therefore, I began to bring to the attention of my parents the fact of the existence of the law “On Immunoprophylaxis,” which gives the right to refuse. Many parents were surprised because they did not know that vaccination is voluntary. They told me that they did not want to vaccinate the child (either in general, or with a specific vaccine) or wanted to postpone vaccination, but they were threatened that without vaccinations they would not be allowed into the kindergarten or given food in the dairy kitchen, and they agreed. I started asking my parents if they knew about the composition of vaccines and the methods of their production. After all, before giving a child any medicine, everyone will look at its composition and possible side effects. It turns out that no one has ever seen the instructions for vaccines before vaccination. No one has seen the usual annotations, in which it is written in black and white what vaccines consist of and the official complications of vaccination (for example, death). One day the chief doctor of a private medical center and asked by what right I give this information to my parents. I replied that my duty, first of all, is to observe the principle of “do no harm,” and a parent should know as much as possible in order to make an informed decision to vaccinate or not to vaccinate. The owner of this private center was also “concerned” and warned me that the center operates under the Ministry of Health program, so I should not give this information to my parents. The fact is that vaccination is also profitable business, a dose of the vaccine can be bought in bulk for a hundred rubles, and “injected” for a thousand. What businessman doesn't like quick profits? They began to follow me, limited access to documentation, citing “medical confidentiality,” I became disgusted and left. I came to the children's clinic to work as a neurologist, thinking that now I would not be associated with vaccination as I was, working as a pediatrician in the garden and in the center. I immediately warned the chief physician that I was wary of vaccination and considered it unacceptable to vaccinate weakened, premature children with obvious neurological problems. The chief doctor agreed with me in many respects, he said that he had always been against vaccination, that the famous pediatrician Dombrovskaya (his teacher) sharply criticized vaccinations, but the latest diphtheria epidemic shook his confidence. He said that he would gladly take me, but he would re-educate me. The everyday life of a neurologist has begun. Neurologists are very careful about vaccination, especially for children with problems nervous system. It is known that hidden or obvious pathology of the nervous system after vaccination can manifest itself in the form of convulsive readiness. That is, vaccination can provoke epilepsy (a described complication of vaccination). In difficult and doubtful cases, I began to give medical exemptions for a month or two from vaccination. Parents asked what to do with the pediatrician, he insists on vaccination. I said that YOU DECIDE, the pediatrician can only recommend vaccination. She said that there is a law “On Immunoprophylaxis”, on the basis of which a refusal to vaccinate can be issued so that the pediatrician “lags behind”. Head The clinic warned: “Step on the throat of your own song.” Once at a consultation there was a particularly severe child at risk of cerebral palsy (in fact, he already had cerebral palsy, but he would be diagnosed with this after a year), I forbade him from vaccination, because against the background of it, cerebral palsy was rapidly progressing. They didn’t listen to me, then I told the head doctor that I abdicated responsibility for such patients. Well, what kind of games are they, really?! The neurologist, understanding the severity of the damage to the nervous system and the unfavorable prognosis, gives a medical advice, and the pediatrician brushes him off like an annoying fly and vaccinates him... In general, they failed to rehabilitate me and I was fired. Pediatricians at the clinic spend five to ten minutes per appointment (to earn more under compulsory medical insurance), so the pediatrician is an assembly line worker and has no time to think. Its main function is to vaccinate children, since other problems will be solved narrow specialists, or he himself with the help of calpols, claritins, flemoxins. Before vaccination, an inspection is carried out “by eye”. After the vaccination, the child’s condition is not monitored, so the pediatrician does not associate the deterioration in the child’s health with the recent vaccination. Neurologists are not in better position- the one who thinks about the consequences of vaccination for a particular child gives a medical opinion, but the issue of vaccination is decided by the pediatrician, from whom they “remove the shavings for under-coverage” of vaccinations. Therefore, the neurologist receives next appointment an even greater problem in the child's health, but the decision to next vaccination– again to the pediatrician. Only parents who understand that vaccination is “a complex immunobiological operation” can break this vicious circle and will not give permission to vaccinate their child if they believe that they need to wait or that vaccinations are harmful and they REFUSE to do them consciously. I have there are healthy unvaccinated children under supervision - these are COMPLETELY DIFFERENT children...

Today, the authorities presented “under glass” the updated local version of the National Vaccination Calendar, determined by the supplied set of vaccines and epidemiological features.
The second round of additional immunization against polio is underway this week.
And finally, from this month we will begin to be fined for failure to comply with the vaccination plan.
These events inspired the creation of another opus about regional problems.
Problem number one is the lack of drugs.
There has been no measles-mumps vaccine for 5 months. No, despite recent measles outbreaks in major Russian cities. No, despite the threat of such an outbreak in our city, given the low vaccination coverage, and especially revaccination. No, despite the seriousness of these diseases in terms of complications. And there will never be separate vaccines against measles and mumps, or a measles+mumps+rubella vaccine.
The same 5 months without tuberculin. In a city where there are about 50 active bacilli shedding people who do not want to be treated. Where there is a practice of unreasonable medical withdrawals from BCG-M in the maternity hospital. Where there is low coverage of fluorographic examination of the adult population.
There were and are no acellular vaccines against whooping cough. In a city where both pediatric neurologists recommend unfounded medical withdrawals from DTP. Where the coverage of revaccination against whooping cough is extremely low. Where whooping cough is detected monthly among both children and adults.
No, and the vaccine against hemophilus influenzae type B is supplied extremely rarely, and in very small quantities. The vaccine is necessary, because cases of both meningitis and epiglottitis have occurred.
There are no and will not be high-quality vaccines against influenza.
There is not and will not be a vaccine against tick-borne encephalitis for children under 3 years old.
Problem number two is refusal to vaccinate.
They are largely due to parents’ ignorance and lack of choice of medications. Commercial medicine also does not solve the latter, and budgetary medicine does not solve the former.
No, well, they will bring “Infanrix”, but “Pentaxim” - no way.
And pediatricians, especially private practitioners, take an anti-vaccination position in principle when the conversation comes up about immunizing children with health problems.
Problem number three is local media.
My immediate boss and I repeatedly tried to invite media representatives to a conversation about the problems of immunization in our city, but each time they found more interesting topics to post. Prevention does not seem to be a hot topic for journalists. Apparently, people with measles or mumps will be an information bomb.
Problem number four is unreasonable medical withdrawals.
Neurologists and DTP have already been announced. But the clinic’s CIC also sins. Diseases are often interpreted as a contraindication to vaccination in principle, and not as a basis for immunizing sick children according to an individual calendar. I have little idea how whooping cough in a patient with epilepsy or poliomyelitis in a patient with primary immunodeficiency will proceed (and how they are going to treat) those who write such a permanent medical advice.
Problem number five—one and a half infectious disease specialists per district.
Well, Isho is working alone in the hospital, although his intentions to leave our city are getting stronger. Another works in a clinic, but is very old. And if an outbreak of an infectious disease occurs or a separate difficult case"controllable" infection, then the guarantees of a favorable outcome are small. Especially if it turns out to be a vacation period or weekends and holidays.
In the middle of this pentagram are local pediatricians who still partially understand the seriousness of the impending threat, and... children who know nothing about it.
It is not for those in the middle to look for solutions.
But those who are above the situation are not looking for solutions.
What are your thoughts?
What problems are there in your city?